Twenty-eight patients have been treated with intraclot, pulse-sprayed tissue plasminogen activator, 27 of whom were available. The veins of 8 patients failed to reopen. Three patients could not be adequately heparinized; their veins rapidly reoccluded. The remaining 16 patients were observed on warfarin for at least 2 months. The offending venous access device (VAD) was left in place in 4 of these patients; 3 suffered venous reocclusion. VADs were removed from the other 12 patients; none of their veins reoccluded. Only 2 patients developed hypofibrinogenemia; neither hemorrhaged. Five patients had minor bleeding episodes.